Background
Methods
Policy, structure, parameters and performance indicators of the programme
Cancer registration
Burden of invasive cervical cancer
Results
Policy and structure of the programme
Point of the guideline | Recommendation of the guidelines | Adherence of the Polish programme to the guideline | |
---|---|---|---|
Legal regulations, guidelines and protocols | Implementation and clinical practice | ||
Screening type | Population-based public healthcare programme, with identification and personal invitation of each woman in the eligible target population | Partial adherence | |
Full adherence. | Postage of invitations is not regulara. | ||
Screening policy | Selection of screening test systems, determining target age group and interval between normal test results, establishing follow-up and treatment strategies for screen positive women | Partial adherence | |
Treatment strategies are not included in organised screening policy. | Large part of triage of abnormal Pap smears is performed outside the programmeb. | ||
Screening test | Cytology | Full adherence | |
Interval between tests with normal results | 3-5 years | Full adherence | |
Age to start testing | 20-30 years of age | Full adherence | |
Age to stop testing | 60-65 years of age. Stopping screening in older women who have had three or more consecutive recent normal cytology results. | Partial adherence | |
No system of stopping organised screening in older women with previous normal smears has been elaborated. | Opportunistic screening in older women is reimbursed and performed regardless of screening history. | ||
Issue of older women who have never attended screening | Special attention should be paid to older women who have never attended screening as they are at increased risk for CC | Partial adherence | |
No systemic solutions have been undertaken to reach women older than 59 who have never attended screening despite unfavourable epidemiological datac. Women older than 59 are not allowed to undergo organised testing regardless of screening history. | Coordinating Offices and the Ministry of Health undertake multiple actions to increase coverage of the programme and to reach non-attenders among women at the screening age 25-59. | ||
Opportunistic screening | Opportunistic screening should be discouraged. It leads to “overscreening” of selected populations and “underscreening” of groups with less socioeconomic status. | Partial adherence | |
Educational campaigns led by Coordinating Offices have been introduced to discourage opportunistic screening but it is reimbursed and recommended in pregnancy [43]. | Private-based opportunistic screening is popular but its extend and outcomes has never been precisely assessed. There are non-governmental initiatives encouraging opportunistic screening at one year intervals in young age groups [44]. | ||
Information system | Implementation of the information system for managing the screening programme; computing the indicators of attendance, compliance, quality and impact and providing feedback. | Partial adherence | |
The implemented system (SIMP) enables computation of selected indicators from organised screening only. | |||
Linkage between information systems and databases | An appropriate legal framework is required for registration of individual data and linkage between population databases, screening files, cancer and mortality registers. | Partial adherence | |
A screening registry (SIMP) is implemented but not fully integrated with other existing systems and some registries are lackingd. | There is routine input of data into several systems, but they are not integrated. | ||
Publication of programme indicators | Indicators of screening programme extension and quality need to be published regularly. | Partial adherence | |
Data available in SIMP are insufficient to generate some of the crucial indicators for publication. | |||
New screening technologies | Before routine implementation of new screening technologies phased piloting or even controlled randomised implementation should be executed for its evaluation under real-life conditions. | Partial adherence | |
Randomisation of screening policies is technically feasible. Pilot programme of primary HPV testing is on the way in two regions. | Comprehensive evaluation of pilot HPV testing will be hampered by partial availability of data on the outcomes in SIMP. |
Point of the guideline | Recommendation of the guidelines | Adherence of the polish programme to the guideline | |
---|---|---|---|
Legal regulations, guidelines and protocols | Implementation and clinical practice | ||
Collection, preparation, handling, staining, screening of samples and reporting of the results | Guidelines must be followed to assure adequate collection and preparation of the samples. The quality of the cytology laboratory depends on adequate handling, staining, screening of slides and reporting of results. | Full adherence | |
Grading of cytological abnormalities | Uniform grading of cellular abnormalities is an essential condition for registration and comparisons. Laboratories should apply only a nationally agreed terminology for cytology which is translatable into the Bethesda Reporting System | Partial adherence | |
The grading system is not fully compatible with the Bethesda 2001 terminology and requires modification (see Additional file 1) | Full adherence to established grading system | ||
Histopathology as the gold standard and its terminology | Histopathology provides the final diagnosis for treatment, is the gold standard for quality control of cytology and colposcopy and is the source of data for cancer registry. Histopathology standards should be monitored and are on the basis of CIN or other internationally agreed-upon terminology. | Partial adherence | |
There is no electronic database of cervical histology results obtained outside the programme. No systematic quality control for histopathology is implemented into the screening programme. There is no automatic or obligatory reporting of histology from the labs to cancer registry. | Only partial data on histopathology of invasive cancers are collected in NCR. | ||
Availability of cytological results for pathologists, accuracy of histological diagnosis, correlation with cytological results. | Histopathologists should be aware and familiar with, the nature of cytological changes that may be relevant to their reports. The accuracy of histopathological diagnosis depends on adequate samples, obtained by colposcopically directed biopsies (with endocervical curettage when necessary) or excision of the transformation zone or conisation, macroscopic description, processing, microscopic interpretation and quality management correlating cytological and histological diagnosis. | Partial adherence | |
There is no central histopathology database and therefore cervical histology results obtained outside the programme are not readily available for analyses and cyto-histological correlations. | Tissue material from biopsies is often assessed at different laboratories than the ones assessing the cytological slides. The availability of data on cytological abnormalities to the pathologists is partiala. Only single local reports exist [51] on local correlations between cytology and histopathology. | ||
Management of screen-positive women | A women with a high-grade cytological lesion, a repeated low-grade lesion or an equivocal cytology results and a positive HPV test should be referred for colposcopy. Guidelines are provided for the management of ASC-US and HSIL. For LSIL repeat cytology or colposcopy are acceptable options and HPV testing in older women can be considered. Quality assurance and collection of data on patient management and follow-up are important in women with abnormal cytology. | Partial adherence | |
HPV testing is not reimbursed within the programme for triage of abnormal Pap results. Only partial data on management of women with abnormal smears are available in SIMP. | Repeat cytology and other triage procedures are commonly performed outside the programme and their results are not registered. Data on triage, management and follow-up are not evaluated and not analysed on regular bases. |
Parameters and performance indicators of the programme
Parameter/year | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 |
---|---|---|---|---|---|---|---|
Population eligible for screening – 1/3 of the population of women aged 25-59 years | 3 227 918 | 3 252 888 | 3 274 036 | 3 289 805 | 3 293 187 | 3 293 976 | 3 290 725 |
Number of invitations sent | 6 027 714 | 2 682 051 | 1 595 319 | 3 202 927 | 3 357 114 | 3 413 678 | 3 220 582 |
Coverage of population by invitations | 186.7% | 82.5% | 48.7% | 97.4% | 101.9% | 103.6% | 97.9% |
Compliance to invitations* | 11.2% | 12.8% | 13.1% | 11.5% | 11.2% | 10.7% | 9.9% |
Number of women screened within the programme | 686 380 | 794 486 | 876 646 | 797 442 | 804 847 | 765 301 | 696 894 |
Coverage rate of organised screening | 21.3% | 24.4% | 26.8% | 24.2% | 24.4% | 23.2% | 21.2% |
Total number of Pap smears collected within NHF outside the screening programme | NA | NA | NA | NA | NA | 1 288 358 | NA |
Total number of Pap smears collected in women aged 25-59 years within NHF outside the screening programme | NA | NA | NA | NA | NA | 807 129 | NA |
Number of women screened outside the programme within NHF opportunistic screening and not screened within the programme within the current 3-year interval | NA | NA | NA | NA | NA | 411 216 | NA |
Combined coverage of organised and opportunistic screening within NHF | NA | NA | NA | NA | NA | 35.7% | NA |
Number of women referred for colposcopy/biopsy within the programme | 4 917 | 6 149 | 9 158 | 9 216 | 9 850 | 9 879 | 10 496 |
% of women referred for colposcopy/biopsy who underwent colposcopy/biopsy within the programme | 41.1% | 50.5% | 46.8% | 34.2% | 31.7% | 31.2% | 29.7% |